Kaohsiung Veterans General Hospital, Taiwan.
Kaohsiung Veterans General Hospital, Taiwan.
Injury. 2019 Oct;50(10):1756-1763. doi: 10.1016/j.injury.2019.09.008. Epub 2019 Sep 6.
Updated three column fixation of tibial plateau fractures (TPFs) arouse the importance of posterior column articular reduction. Complex TPFs with posterolateral (PL) articular injury is difficult to manage. We presented a strategy of combined positions and approaches to treat these injuries. Surgical technique was described and outcome of these were reported.
From 2014 Jan to 2016 Dec, there were 132 patients of TPFs treated in our institute. Preoperative evaluation included plain films and 2D/3D CT scan to evaluate the involvement of articular surface and associated columns. Inclusion criteria were three column TPFs with PL corner injury. We put patients in prone position first with reverse L incision to manage PL articular impaction and posteromedial (PM) fractures. Then we repositioned the patients in supine to treat anterolateral fixation. Postoperative radiographic analysis, physical examination findings, and patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were recorded.
Patient demographic information was retrospectively reviewed with a mean follow-up time of 34.4 months (range 24-48 months). The average time to union was 5.2 months (range 4-8months). 13/16 (81%) of patients had satisfactory articular reduction by plain films (less than 2 mm articular step off). All patients demonstrated healed without secondary displacement or infection. All patients demonstrated satisfactory coronal (medial proximal tibia angle 84.68 degrees) and sagittal alignment (posterior proximal tibia angle 84.75 degrees). Condylar width averaged 3.93 mm. 3/16 (19%) of cases required posterolateral columnar plating in addition to posteromedial columnar plating. The knee range of motion averaged 115 degrees (ranged from 0 degrees of extension to140 degrees flexion). The average KOOS score was 83/100 (range 76-90). 3 patients in the series developed a surgical site superficial infection and resolved after debridement and oral antibiotics use. No patient eventually received total knee arthroplasty at the last follow up.
Our strategy provides an effective method to treat three column tibial plateau fractures with PL articular injury.
胫骨平台骨折（TPF）的更新三柱固定引起了后柱关节复位的重要性。伴后外侧（PL）关节损伤的复杂 TPF 很难处理。我们提出了一种联合体位和入路治疗这些损伤的策略。介绍了手术技术，并报告了这些损伤的结果。
自 2014 年 1 月至 2016 年 12 月，我院收治 TPF 患者 132 例。术前评估包括平片和二维/三维 CT 扫描，以评估关节面和相关柱的受累情况。纳入标准为三柱 TPF 伴 PL 角损伤。我们首先让患者俯卧位，采用反 L 切口处理 PL 关节嵌顿和后内侧（PM）骨折。然后我们让患者仰卧位治疗前外侧固定。记录术后影像学分析、体格检查结果和患者报告的膝关节损伤和骨关节炎结果评分（KOOS）问卷的结果。
回顾性分析患者的人口统计学信息，平均随访时间为 34.4 个月（24-48 个月）。平均愈合时间为 5.2 个月（4-8 个月）。13/16（81%）例患者的 X 线片显示关节复位满意（关节台阶小于 2mm）。所有患者均无继发性移位或感染。所有患者的冠状面（胫骨近端内侧角 84.68 度）和矢状面（胫骨近端后角 84.75 度）均显示满意的排列。髁间宽度平均为 3.93mm。16 例中有 3 例（19%）需要加用后外侧柱钢板固定。膝关节活动度平均为 115 度（伸展 0 度至屈曲 140 度）。平均 KOOS 评分为 83/100（76-90）。该系列中有 3 例患者发生手术部位浅表感染，经清创和口服抗生素治疗后痊愈。末次随访时，无患者最终接受全膝关节置换术。
我们的策略为治疗伴 PL 关节损伤的三柱胫骨平台骨折提供了一种有效的方法。
